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Protocol: standard weight management with niacinamide support Goal: Weight loss with enhanced cellular energy support Formulation: Semaglutide 2.5 mg/mL + Niacinamide 2 mg/mL Dose escalation schedule: Weeks 1-4: 0.25 mg semaglutide (0.1 mL) weekly Weeks 5-8: 0.5 mg semaglutide (0.2 mL) weekly Weeks 9-12: 1.0 mg semaglutide (0.4 mL) weekly Weeks 13-16: 1.7 mg semaglutide (0.68 mL) weekly Week 17+: 2.4 mg semaglutide (0.96 mL) weekly, or as tolerated Supporting measures: Protein intake: 1.2-1.6 grams per kg body weight daily (to preserve muscle) Hydration: minimum 2-3 liters water daily Consider additional oral niacinamide (250-500 mg daily) if fatigue persists, with provider approval Monitor energy levels, documenting changes weekly Blood work at baseline and every 3 months: metabolic panel, B vitamins, liver enzymes Expected timeline: Weeks 1-4: Minimal weight loss, adjustment period, possible nausea Weeks 5-8: Weight loss begins to accelerate , appetite suppression strengthens Weeks 9-16: Steady weight loss of 1-2% body weight per month Months 4-6: Continued progress toward goal weight Months 6-12+: Maintenance phase at optimal dose Protocol: enhanced energy focus Goal: Combat fatigue while maintaining weight loss momentum Same dose escalation as above, with these additional measures: Oral niacinamide supplement: 500 mg twice daily (with meals) to boost NAD+ beyond injectable dose CoQ10 supplementation: 100-200 mg daily (supports mitochondrial electron transport chain) Magnesium glycinate: 200-400 mg at bedtime (supports energy production and sleep) B-complex vitamin: daily, to support all energy metabolism pathways Track energy levels on a 1-10 scale daily for the first 8 weeks This enhanced protocol recognizes that the 2 mg injectable niacinamide dose alone may not be sufficient to meaningfully impact NAD+ levels
Retatrutide (LY3437943) simultaneously activates GLP-1, GIP, and glucagon receptors, distinguishing it from approved dual or single agonists such as tirzepatide and semaglutide
Contributors from my own department are mentioned in the Acknowledgment
The downsides (aka side effects) Heres where I get to pop the excitement balloon
Support that honors your goals
doi:10.3810/pgm.2009.03.1984 Dolin BJ
